Tag: erections

Two-stage urethroplasty: stage 1, 8 weeks after surgery

Still no major changes. The stitches are dissolving gradually, only a few are left but one of them in particular seems to be digging in a bit and causing an occasional spot of blood.

This is what it looks like this week.

Since the dressing came off I’ve been using male incontinence pads under my normal underwear. Fortunately I haven’t had any problems with incontinence but there was some seepage from the wound. That’s pretty much stopped now but I want to keep the wound clean and also hold my penis pointing upwards and prevent rubbing.

One good thing since the post-surgery swelling died down is that the curving of my penis when it’s erect is gone. It’s now back to how it used to look, apart from the gaping wound on the underside.

After having had the catheter for so long I was expecting more trouble with retraining my bladder. At first I was having to run to the toilet quite often, and urgently, but that seems to have passed now.

Two-stage urethroplasty: stage 1, 12 days after surgery

I’m free of catheters!

After a short wait at the hospital the surgeon removed all the dressings and removed both catheters. There are some before and after pictures here.

So it seems like the graft is looking good, all pink and healthy. The surgeon was initially a bit concerned about infection because of the whitish stuff around the edges but there’s no irritation and she decided it’s just the usual result of having a catheter in and no washing for a week.

Now I can pee sort of normally. I have to sit down and the pee either shoots along the underside of my penis or dribbles down my scrotum but for the first time since October I can actually pee.

I also realised another unpleasant part of not being able to wash properly for almost three weeks, the head of my penis was covered in smegma. Fortunately it was quite dry and not smelly. A quick wash fixed that problem.

My next visit to the hospital (barring unforeseen developments) will be in September, to assess the graft before the second-stage surgery a month later.

Two-stage urethroplasty: stage 1, 11 days after surgery

The local anaesthetic worked for the pain in my cheek. The pain was so bad that it was feeling as if my teeth and jaw were also aching. Doses of xylocaine gel before meals, before going to bed and whenever the pain got too bad helped enormously.

Fortunately the nerve seems to have healed up a bit. I get the occasional ache but nothing so severe and I’m now only using the xylocaine before brushing my teeth.

Erections are still painful but the pain is well controlled by the slow-release painkillers. Pain during the day is now at the point where I can forget to take my paracetamol without it making a huge difference.

One current problem is the smell from the dressing. The surgeon warned me it would start to smell unpleasant but this is worse than I could have expected. I suppose it’s a combination of dried blood and exudate from the wound plus all the things that you normally wash away from your crotch and penis. The smell is best described as appalling. On the plus side it doesn’t smell like anything is rotting, so I’m not worried about it.

So, I just have to wait until tomorrow to find out how the graft is doing. It’ll be a huge olfactory relief just to get a new dressing and a bit of a wash down there.

Two-stage urethroplasty: stage 1, one week after surgery

Later today it will have been a week since my urethroplasty surgery. I’m now back home and sleeping much better, even if my activity is still very restricted (on doctor’s orders).

This time I seem to have managed to successfully communicate to the doctors that my main problem is with painful erections and now that I have some slow-release opioids I can sleep through the night without those disturbing me.

Unfortunately now my cheek is giving me trouble. It has tended to ache occasionally since the surgery but the last couple of days the level of pain has been getting much worse. It comes and goes and doesn’t really seem to be helped by any of the painkillers (paracetamol, ibuprofen or morphine).

Last night I kept getting really terrible pain if I rolled onto my left side. I could feel the weight of my wounded right cheek settling onto my teeth and it was unbearable. Morphine didn’t help, I just had to wait for the wave of pain to pass. Brushing the teeth in the right side of my mouth is impossible.

My husband (he’s a doctor) has suggested that it could be being caused by a damaged nerve in my cheek. We’re going to try local anaesthetic gel, to see if that will help at all.

Two-stage urethroplasty: stage 1, 5 days after surgery

My final night in the hospital was probably the best since surgery. I’d set alarms to wake me up to take morphine so that it wouldn’t wear off completely during the night, that seemed to be a success.

Just after breakfast the surgeon came round and removed the dressing on my penis. Apparently everything is looking good, you can see that the graft is looking pink and healthy through the gel dressing in the photos. So I’m to come back through in a week so that she can have another look and I can get rid of at least one of the catheters.

Actually getting discharged took most of the rest of the day. A nurse turned up with a load of discharge paperwork. I refused the catheter bags they were offering since I’ve already got a good stock of ones that I know I can get on with. Then a junior doctor came to discuss prescriptions for drugs to take home.

The admin staff on the ward were kind enough to arrange for transport from home to the hospital for next week’s visit, since I can’t drive or take public transport. Dealing with the part of our county council that handles that stuff is usually unpleasant.

So I finally got away from the ward and stopped at the pharmacy in the hospital to pick up my prescriptions. Except the junior doctor had forgotten to submit them (electronically). My husband went and spoke with him and fixed that. Next we discovered that he hadn’t remembered all of the drugs, but the pharmacist called him and sorted that out.

I still couldn’t pick up the last of the drugs because some delay in the system meant that the pharmacist couldn’t see that prescription, so we decided to pick them up on our way home.

The drive home was fairly comfortable, some pain on rough sections of road but nothing too bad. My cheek and jaw were starting to hurt again though.

For the next week I’m pretty much trapped at home and to keep activity to a minimum. I may have a go at working from home but I’m not sure how long I’ll be able to sit at a desk.

Two-stage urethroplasty: stage 1, 4 days after surgery

This time it was a pretty mixed night. It started very badly, with constant disruptions from my roommate. It seemed he kept tangling, kinking and pulling out his various tubes. So the nurses would arrive, turn on the lights and start speaking to him extremely loudly. He also had his CPAP machine, which was surprisingly quiet. Unfortunately it sounds like a vacuum cleaner if you pull off the mask and leave it running, which he kept doing.

The poor old soul’s on his last legs and a bit confused, so I can’t be too annoyed. On the other hand it would be nice if he wasn’t in a room with me.

Later in the night I managed to sleep fairly solidly, without disruptions or pain. Unfortunately by about 04:30 all the painkillers had left my body and it was time for the most painful erection yet. It really felt like something was going to burst. Fortunately the (male) nurse on duty was very quick to bring paracetamol and morphine.

So now that the fog has lifted the sun is shining into my room and this will hopefully be my last full day in the hospital (this time).

Two-stage urethroplasty: stage 1, 3 days after surgery

A much better night. I’d worked out that the morphine tablets last two or three hours. So I took one about half an hour before going to sleep. Before falling asleep I managed to get an erection, desperately trying to think about other things but without any effect.

During the night I asked for more morphine when I felt I needed it and actually got an OK night’s sleep.

The doctor at rounds said she’d remind the nurses to just leave the morphine tablets with me, so I don’t have to keep calling them during the night.

Washed and got dressed and then spent the rest of the morning working out how to defeat the stupid filtering on the hospital’s internet. As well as blocking websites they try to block anything apart from web browsing and it seems like their DNS is pretty broken too. For example today I suddenly got DNS errors for this site. Actually it seems like all .uk sites get DNS errors.

After lunch my husband came to visit and took me out for a bit of a spin in a wheelchair. Although sitting upright isn’t all that comfortable yet it was great to get a decent cup of coffee and go for a stroll/roll along the river. He also helped me wash my hair, which was sorely needed.

 

Two-stage urethroplasty: stage 1, 2 days after surgery

I started off the night dozing fitfully but eventually managed to get to sleep properly but interrupted by painful erections. At one point I called for a nurse, she came, ignored me, peered at my roommate and then left (I tried to call out but too hoarse). I pressed the button again and she eventually came back and started fiddling with my roommate’s catheter tubing. I said excuse me and she told me to wait until she was finished. Eventually she came over to my bed and I told her I was in quite severe pain. Of course I had to call and remind her again before she actually turned up with some morphine.

After breakfast and rounds I got up and had a wash, which made me feel a lot more human. The nurses changed my bedding so I wasn’t lying in my own bloodstains and shaved-off pubic hair any more. I got dressed in the hospital day clothes, that make you look like a convict.

I had a lot of trouble staying awake, so I dozed for a bit, having very weird half-awake dreams.

Lunch was isterband, which was OK but unfortunately slightly spicy and irritating to my cheek.

Dozed some more in the afternoon. Had some coffee but it wasn’t enough to keep me awake.

The evening was spent on Skype calls and Hangouts chats with family.

Two-stage urethroplasty: stage 1, 1 day after surgery

I had a fairly disturbed night, waking up a lot. After I got some morphine I finally managed to get off to sleep properly but was woken up by the searing pain of an erection at about five. Like last time, it’s nice to know things are still working but I could do without the pain.

Cornflakes with yoghurt and a cup of coffee for breakfast, without any serious pain from my cheek. It’s really amazing how quickly that heals.

At rounds I was told I could get up a little bit, but shouldn’t walk about too much. My night-time drug prescription was changed too, so I’d get a morphine tablet to take if I woke up during the night. The dressing was looking fine, no blood seeping through.

The cannula in my left elbow had come quite loose, the dressing hadn’t stuck very well in the first place and was hanging off. I asked three nurses to fix it but they all forgot. Eventually I managed to get a nurse who could do that and bring me a bowl so that I could brush my teeth.

I got up in the afternoon to change from the surgical gown into a nightshirt. Not much of an improvement but at least it doesn’t expose my arse to all and sundry. I made it through to the bathroom in the evening to clean my teeth. Getting in and out of bed is pretty painful but standing was OK.

During the day the confused elderly guy in the next bed was discharged and a new old man appeared with his wife. At least they said hello and introduced themselves.

Fourth week after operation

The suprapubic catheter they put in (held in by stitches) before I was discharged from the hospital is a bit different from the others I’ve had. It has two separate parts: the narrow catheter tube itself (clear silicone) and the adapter to connect it to a drainage bag.

Unfortunately the two parts can be separated quite easily and this occasionally happens if the catheter tubing slips through the adhesive catheter holders. On Tuesday morning it pulled off and I didn’t notice until the urine had soaked through my t-shirt. This time I’ve arranged it so that one catheter holder is holding the adapter and the catheter tube has plenty of slack.

I got an appointment for the cystourethrogram for Wednesday the 10th. After that the doctors will be able to decide whether my urethra has healed and isn’t leaking. If everything is OK the suprapubic catheter will come out and I’ll be back to peeing normally.

I also got an appointment with a nurse on Monday the 8th. There was nothing to say what the appointment was for so I contacted the urology department. It turns out that they’d messed up the scheduling and the nurse was going to remove the suprapubic catheter before the x-ray appointment. They fixed it so that I’d just go up to urology straight after the cystourethrogram.

I’d thought the worst of the night-time erection pain was over, but in the early hours of Thursday I woke up with one and was just dozing off again when I felt three sharp pains inside my penis, along with a strange snapping sensation. I’m assuming it was some of the remaining stitches that had partially dissolved and were snapped by the tension. Since that I don’t get any pain with erections, just a sensation of tightness along the urethra.

Things are starting to look more normal, the scar is fading nicely with just one reddish patch. I can still feel inflammation along the whole repaired stretch of urethra but I had the same after the urethrotomy and that seems to take a couple of months to go away.

Operation + 5 days (Sunday)

Had a less horrible night, still woken by painful erections but managed to at least get a few solid hours of sleep.

The catheter night bag was really full and difficult to empty. When I cut the corner off a jet of urine sprayed the area around the toilet, so I had to wipe it up and mop the bathroom.

I managed to poop for the first time in four days and without any spasms. I’d avoided caffeine during the day, so maybe that helped.

Operation + 4 days (Saturday)

I had a horrible night with a persistent semi-erection from about 04:00, usually becoming fully erect with about 15 minutes of me dozing off.

The dressing on my penis was in need of replacement but we didn’t have the supplies to do it. While everything is more visible I could see that my penis is looking quite twisted but that was apparently due to internal bleeding and swelling and will resolve itself. Click here for photos.

I risked some coffee at lunch but then had some horrible bladder spasms in the afternoon. I’m not sure if the two things are related.

Operation + 3 days (Friday)

I slept fairly well, still with the occasional erections waking me.

Still no output from the suprapubic catheter so I headed up to the urology ward around 08:30. They seemed to be expecting me, so I sat at my bed and waited for rounds.

The doctor suggested trying flushing out the suprapubic catheter again. So a nurse came round to do that. As she removed the dressing from the suprapubic catheter the whole thing came along with it. I could see quite clearly that the balloon had burst and the catheter had obviously pulled out of my bladder.

It looked a lot like when the nurse had used forceps to remove the old catheter bag that had over-pressurised the balloon and burst it.

After a quick consultation with the doctor and a more senior nurse it was decided that I’d manage over the weekend with just the one catheter and go back in for discharge on Monday as planned.

I had a comfortable afternoon at home watching TV. The upside of not having the suprapubic catheter is that I didn’t have any of the belly discomfort I’d had since the operation.

The non-stick dressing on my penis and scrotum had started to come away from the stitches so I could see how far down onto my scrotum the wound went. That explained why there was so much tenderness and bruising down there. Click here for photos.

Sleeping was easier with only one tube to wrangle.

Operation + 2 days (Thursday)

With the paracetamol I could lie comfortably on my side, so I got to sleep quite quickly. I still got woken several times during the night by very painful erections.

I really didn’t want more of them so at about 04:30 I decided to stay awake until breakfast. Then I dozed off again and wasn’t woken by another erection until just before 07:00.

Before rounds I let the nurses know I’d like to go home on leave. In Swedish hospitals they’ll let you go home before you’re officially discharged on what they call permission. The doctor on rounds agreed that I’d be fine at home. He changed the dressing on my penis; the old one had got pretty grotty by this point.

A bit later the nurses swapped to leg bags for both of the catheters. They had a terrible time removing the original ones I’d got after surgery. Those catheters had a threaded connector rather than the usual push-fit ones and they just wouldn’t come out. One of the nurses ended up using forceps to grip the catheter tubing.

After lunch my husband came to take me home. Having not had a decent night’s sleep for a couple of days I felt like a nap in the afternoon. That was when we discovered that the nurse had cut the leg bag tubes so short that the bags had to lie beside me on the bed. I also noticed that nothing had come out through the suprapubic catheter since the bag change.

I slept for an hour or so and then woke up with a feeling of pressure in my bladder. The urethral bag had filled (to it’s tiny 500 ml capacity) but there was still nothing in the other bag. When I emptied the bag a strong bladder spasm squeezed urine out around the urethral catheter, leaving a lingering burning sensation.

In the evening we took the bus back up to the hospital to have them check the suprapubic catheter. When the nurse tried flushing it out nothing came out of the urethral catheter but I got a feeling of pressure and water leaked out of the suprapubic wound.

Further attempts to squirt saline into and suck saline out of the two catheters didn’t result in much. So I drank some water and waiting to see if the suprapubic catheter had started working again. It hadn’t, so we went home but with some better leg bags this time.

This time I could organise the tubing much more comfortably, with the leg bags hanging off a drawer on my bedside cabinet, and got to sleep quite early.

Operation + 1 day (Wednesday)

I woke up during the night with a feeling of pressure in my bladder. The bag had filled up so I had to call a nurse to empty it. After that they started checking regularly.

I was woken again by an erection at about 05:30. It was very painful but it was a relief to know that things were still working. After a second one I was kind of scared to go back to sleep so I just read. Bright sunshine was already coming in through the windows at 06:30.

The nurses came around eight but kept being distracted by other patients. They told me they’d rearrange all my tubes so that I could get up but by then it was breakfast time. Egg, bread, cheese and ham and I even managed to drink the coffee once I’d let it cool down.

My re-plumbing was delayed again waiting for the surgeon’s round. When he appeared he told me it had gone well. The stricture was about 1.5 cm (as they’d seen on the urethrogram) but they’d had to repair about 5 cm of unviable urethra (scarring from the urethrotomy?). I asked him about the painful erections but he seemed a bit awkwarded-out. He wanted to keep me in until Monday for monitoring.

I eventually got a new dressing and better catheter bags and clothes. Had a wash at the sink, because my dressings mustn’t get wet. My scrotum was still quite purple. Click here for photos.

I had coffee with the young guy from the opposite bed, who’d also had some kind of urethroplasty, and the old guy from the next bed. It was quite nice to be up and about, even if I did have to carry my two catheter bags with me in a plastic bag.

My husband turned up for lunch, mine didn’t arrive until a bit later (slimy kalops and runny apple purée). We went for a walk around the hospital. Standing up straight was quite hard because my belly muscles are very tense and I was getting quite frequent bladder spasms.

I spent the afternoon reading, interrupted occasionally by nurses coming to measure me. I asked for a jug of water when I realised there wasn’t much urine in the catheter bags.

At one point I was sitting reading when all of a sudden an air bubble forced its way out past the urethral catheter with a loud cracking noise and a sharp pain. I called a nurse but apparently it’s normal. Another interesting new experience.

In the evening I got told off by a nurse for emptying my own catheter bags. Apparently they wanted to do it so they could record the amount of urine, but of course they hadn’t told me that. The nurse showed me how to inject the blood thinners and had me do it myself.

I got some paracetamol for pain during the night and it was time for bed. Still feeling quite bloated and crampy.

After urethrotomy

So a week after the surgery I had the usual problems that guys seem to have with catheters but that nobody bothers to tell you about.

Being woken up during the night when erections meant that my penis simultaneously tried to pull out the catheter and scraped it over the inside of my urethra was a new experience, and one I could have happily done without. After a couple of days I learned to tape the catheter into a position that minimised the unpleasantness.

I think that night-time erections were a particular problem for me because my penis changes a lot in size between flaccid and erect. So an erection meant pulling an extra 10 cm or so of catheter over my wounded urethra. It was also a latex catheter and they seem to be stickier than the other types.

During the week with the catheter I worked from home and tried to avoid walking around too much. I never did find a position for the tubing that didn’t become uncomfortable while walking.

Having the catheter removed was very easy, although slightly delayed by a massive failure of the county’s healthcare IT system that morning. The nurse deflated the balloon and pulled it out smoothly, all I felt was a slightly odd sensation and it was done.

I went straight back to work afterwards and discovered that the catheter had left my prostate a bit tender, so I needed to use a soft cushion on my office chair.

A few days later I started feeling like I had flu or something. Several colds and flus were going around the office at the time but my husband insisted I go to the emergency room and it turned out I had a fairly severe urinary tract infection. By the time I was admitted to the urology ward, around midnight, I was sweating profusely and feeling pretty grim.

They kept me in the hospital for three days while the antibiotics started to take effect. When I was discharged I had a meeting with the doctor who’d done the urethrotomy. I was a bit concerned that I hadn’t had any night-time erections for a few days (which was probably just due to being really ill) but he just casually said that it could be a complication of the surgery and made a weird comment about the next step being anastomosis and that that would likely cause shortening of the penis. It was an odd thing to say both because anastomosis isn’t at all a suitable surgery for strictures in the penile urethra and because it had nothing to do with the question I’d asked.

After a week of recovery I could concentrate for long enough to go back to work, although the infection had settled in my prostate and needed another couple of weeks of antibiotics to be completely rid of it.